Abstract
Background
The outcome of total knee arthroplasty (TKA) after high tibial osteotomy (HTO) is still controversial. In order to determine if osteotomy has any effect on this outcome we performed a medium-term review of a cohort of patients with knee osteoarthritis.
Materials and methods
Thirty-two patients (38 knees), who were treated with a HTO before the TKA during the last 8 years, were compared with a matched group who underwent primary TKA. The knees were evaluated preoperatively and postoperatively according to the scoring systems of the Knee Society and Hospital for Special Surgery (HSS). The anteroposterior tibiofemoral alignment, the Insall–Salvati patellar position ratio, range-of-motion and the location of the lateral joint line, were also recorded. The patients were reviewed with a mean follow-up of 4.5 years after TKA.
Results
The preoperative and postoperative knee scores had no statistically significant differences between the two groups. So was the case with the intraoperative releases, blood loss, thromboembolic or neurologic complications and infection rates in either group. Access to perform the arthroplasty was reportedly more difficult and took an average of 25 min longer. A significant difference (p < 0.05) was detected in terms of impingement of the tibial stem on the lateral tibial cortex, patellar subluxation and patella baja between the two groups but this did not have any influence on the outcome of the prosthesis. Knee alignment and stability so as range of motion (ROM) measurements were also found with no statistical significance.
Conclusion
Although we did manage to detect statistically significant differences mainly in radiographic results between the two groups, this situation did not appear to influence the clinical outcome of the patients, however. The fact that most of the patients had good or excellent results at an average follow-up of 4.5 years suggests that HTO does not have a significant negative effect on later TKA.
Similar content being viewed by others
References
Insall JN, Joseph DM, Msika C (1984) High tibial osteotomy for varus gonarthrosis: a long-term follow-up study. J Bone Joint Surg Am 66(7):1040–1048
Odenbring S, Egund N, Knutson K, Lindstrand A, Larsen ST (1990) Revision after osteotomy for gonarthrosis: a 10–19 year follow-up of 314 cases. Acta Orthop Scand 61(2):128–130
Nagel A, Insall JN, Scuderi GR (1996) Proximal tibial osteotomy: a subjective outcome study. J Bone Joint Surg Am 78(9):1353–1358
Bettin D, Karbowski A, Schwering L, Matthiass HH (1998) Time-dependent clinical and roentgenographical results of Coventry high tibial valgisation osteotomy. Arch Orthop Trauma Surg 117(1–2):53–57
Katz MM, Hungerford DS, Krackow KA, Lennox DW (1987) Results of total knee arthroplasty after failed proximal tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 69(2):225–233
Windsor RE, Insall JN, Vince KG (1988) Technical considerations of total knee arthroplasty after proximal tibial osteotomy. J Bone Joint Surg Am 70(4):547–555
Rorabeck CH, Smith PN (1998) Results of revision total knee arthroplasty in the face of significant bone deficiency. Orthop Clin North Am 29(2):361–371
Staeheli JW, Cass JR, Morrey BF (1987) Condylar knee arthroplasty after failed proximal tibial osteotomy. J Bone Joint Surg Am 69(1):28–31
Neyret P, Deroche P, Deschamps G, Dejour H (1992) Prothese totale du genou apres osteotomie tibiale de valgisation. Rev Chir Orthop 78(7):438–448
Bergenudd H, Sahlstrom A, Sanzen L (1997) Total knee arthroplasty after failed proximal tibial valgus osteotomy. J Arthroplasty 12(6):635–638
Gill T, Schemitsch EH, Brick GW, Thornhill TS (1995) Revision total knee arthroplasty after failed unicompartmental knee arthroplasty or high tibial osteotomy. Clin Orthop 321:10–18
Mont MA, Antonaides S, Krackow KA, Hungerford DS (1994) Total knee arthroplasty after failed high tibial osteotomy: a comparison with a matched group. Clin Orthop 299:125–130
Ries MD, Richman JA (1996) Extended tibial tubercle osteotomy in total knee arthroplasty. J Arthroplasty 11(8):964–967
Takai S, Yoshino N, Hirasawa Y (1997) Revision total knee arthroplasty after failed high tibial osteotomy. Bull Hosp Joint Dis 56(4):245–250
Masri BA, Campbell DG, Garbuz DS, Duncan CP (1998) Seven specialized exposures for revision hip and knee replacement. Orthop Clin North Am 29(2):229–240
Whiteside LA (1997) Surgical exposure in revision total knee arthroplasty. Instr Course Lect 46:221–225
Insall NJ, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop 248:13–14
Insall NJ, Ranawat CS, Aglietti P, Shine J (1976) A comparison of four models of total knee replacement prostheses. J Bone Joint Surg Am 58:754
Insall NJ, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101–104
Mont MA, Alexander N, Krackow KA, Hungerford DS (1994) Total knee arthroplasty after failed high tibial osteotomy. Orthop Clin North Am 25:515–525
Cameron HU, Park YS (1996) Total knee replacement following high tibial osteotomy and unicompartmental knee. Orthopedics 19(9):807–808
Toksvig-Larsen S, Magyar G, Onsten I, Ryd L, Lindstrand (1998) A fixation of the tibial component of total knee arthroplasty after high tibial osteotomy: a matched radiostereometric study. J Bone Joint Surg Br 80(2):295–297
Amendola A, Rorabeck CH, Bourne RB, Apyan PM (1989) Total knee arthroplasty following high tibial osteotomy for osteoarthritis. J Arthroplasty 4(suppl):S11–S17
Nizard RS, Cardinne L, Bizot P, Witvoet J (1998) Total knee replacement after failed tibial osteotomy: results of a matched-pair study. J Arthroplasty 13(8):847–853
Scuderi GR, Windsor RE, Insall JN (1989) Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg Am 71(2):245–247
Cameron HU, Welsh RP (1988) Potential complications of total knee replacement following tibial osteotomy. Orthop Rev 17(1):39–43
Krackow KA, Holtgrewe JL (1990) Experience with a new technique for managing severely overcorrected valgus high tibial osteotomy at total knee arthroplasty. Clin Orthop 258:213–224
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kazakos, K.J., Chatzipapas, C., Verettas, D. et al. Mid-term results of total knee arthroplasty after high tibial osteotomy. Arch Orthop Trauma Surg 128, 167–173 (2008). https://doi.org/10.1007/s00402-007-0488-3
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-007-0488-3